Risk of health care professionals acquiring HIV infection in Latin America

This study describes the professional risk of acquiring HIV infection while caring for AIDS patients at a teaching hospital in Brazil. Since 1985 we have tested health care professionals (HCP) for HIV-1 antibody after accidents with blood and body fluids from AIDS patients. The blood samples were tested twice using an ELISA FDA approved test and, if positive, we performed Western blot. Two hundred and forty seven health care professionals reported 338 accidents (50% were percutaneous and 22% were mucous membrane exposures to blood). A further 404 HCPs reported no occupational exposure but wanted to be tested. From 247 HCPs with at least one accident, we analyzed 115 with more than 6 months of follow up. None were HIV antibody positive. Nobody received zidovudine as a prophylaxis. Of the 404 HCPs with no accident, 6 (1.5%) were positive and had confirmed risk factors for HIV. Our results support other studies that report a low occupational risk (about 0.4%) of acquiring HIV infection.     

The first case of acute HIV and monkeypox coinfection in Latin America

Monkeypox (MPX) transmission outside non-endemic countries has been reported since May 2022, rapidly evolving into a multi-country outbreak. A potential role of sexual contact in transmission dynamics, as well as a predominance of anogenital lesions, are remarkable features of current cases. Screening for sexually transmitted infections (STIs) plays an important role in the evaluation of patients with suspected MPX infection. Herein we report the first case of a patient diagnosed with both MPX and acute HIV infection in Latin America. He had no major complications during his clinical course, and antiretroviral therapy was promptly initiated. Diagnosis of acute HIV requires a high level of suspicion and appropriate laboratory investigation. Health practitioners need to consider this diagnosis while evaluating patients with suspected MPX with a recent unprotected sexual contact.     

Myths about the prevention and control of non-communicable diseases in Latin America

Given the increase of the burden of non-communicable diseases (NCD) and the possibility to avoid it, it is urgent to implement or strengthen NCD preventive programs in Latin America. However, many myths hinder the implementation of NCD programs. Myths on NCD include: a) NCD are degenerative and incurable; b) they are diseases of the elderly; c) they are diseases of the rich. Like wise there are myths about NCD preventive programs are: a) difficult to implement, b) expensive, and c) ineffective. We present data that demonstrate how these myths are untrue and discuss the challenges to find a balanced health policy that emphasizes the importance of NCD without overlooking other diseases.     

Leptospirosis in Latin America

Leptospirosis is a common disease in Latin America. Transmission to humans occurs by contact with water or soil contaminated with the urine of rodents, dogs, or livestock. Pathogenesis is still poorly understood, and bacterial toxin or virulence factors are probably responsible for many features of the disease. The anicteric form is the most frequent presentation, and its clinical picture resembles influenza or other acute febrile diseases. Icterohemorrhagic leptospirosis, or Weil's syndrome, represents the severe form of the disease. Its clinical picture is similar to bacterial sepsis and multiple organ involvement occurs, mainly in kidneys and lungs, and causes great morbidity and mortality. Death is often related to multiple organ failure and pulmonary hemorrhages. Diagnosis is based on serology or blood, cerebrospinal fluid and urine cultures in specific media. Treatment involves a combination of antibiotics and supportive measures.     

AIDS in Latin America

The epidemic in Latin America has placed an unexpected additional burden on the health care systems and national economies, already weak and affected by severe problems. Specific regional diseases in addition to common opportunistic infections, and particularly the high incidence of TB, produce a different picture compared with the United States and Europe. Access to ARV therapy is far from being universal in Latin America; nevertheless, some countries are providing HAART to all eligible patients, showing that it is not impossible to improve quality of care for people living with HIV infection in the region. Before assuming as definitive and irreversible that at least one or two generations will be sacrificed on the altar of inequity of our uneven world, we as acting scientists should join the struggle of millions of human beings claiming their right to be treated with the best drugs that science can offer today.     

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

Intended and unintended pregnancies occur frequently among human immunodeficiency virus (HIV)-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1–5.7). Younger age (odds ratio [OR]?=?1.07, 95% confidence interval [CI]: 1.04–1.11 per one year decrease in age), hospitalization during the index pregnancy or up to six months post-partum [OR?=?2.0, 95% CI: 1.2–3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion; OR?=?3.4, 95% CI: 1.4–8.4) were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (vs. prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p?相似文献   

The importance of HIV prevention messaging for orphaned youth in Zimbabwe

The AIDS epidemic has contributed to a drastic increase in the number of orphans in Zimbabwe. Female adolescent orphans are particularly in jeopardy of contracting HIV due to disadvantages including extreme poverty, low education, and the absent of parental oversight which can lead to higher risk-taking sexual behaviors. By understanding where girls receive education about HIV and who they rely on for information, organizations can effectively modify existing programs to better target this at-risk population. For this study a household survey was conducted which included 216 orphans and 324 non-orphans (n=540), aged 12-17 years, in the resource-poor setting of Hwange District, Zimbabwe. The aims of this article were to examine the differences between orphans and non-orphans in HIV prevention message exposure, level of motivation for learning about HIV, and communication with caregivers about safe sex. The household survey revealed that younger orphans, aged 12-15 years, were more motivated to learn about HIV and had greater HIV messaging exposure in school than non-orphans. These exposure and differences in the levels of motivation between groups dissipated at older ages. Our research also discovered less caregiver communication among orphans than non-orphans. Our findings suggest that HIV programs targeting orphans need to do a better job at keeping older orphans interested in HIV prevention at a time when it matters most. Furthermore, intervention strategies that provide caregiver support are instrumental in effectively delivering prevention messages to girls at home.     

New paradigms and challenges in cervical cancer prevention and control in Latin America

Cervical cancer continues to be a significant health problem in Latin America. The use of conventional cytology to detect precancerous cervical lesions has had almost no major impact on reducing cervical cancer incidence and mortality rates, which are still high in the region. The availability of new screening tools to detect precancerous lesions provide great opportunities for cervical cancer prevention in the region, as do highly efficacious HPV vaccines able to prevent nearly all lesions associated with HPV-16 and -18 when applied before viral exposure. This paper summarizes the scientific evidence and regional experiences related to: i) the use of HPV testing and visual inspection after the application of acetic acid (VIA) in primary screening and ii) the implementation of adolescent HPV vaccination programs. Finally, we outline a number of recommendations for different resource settings. The feasibility of implementing successful and sustainable national cervical cancer prevention programs in Latin American countries in the region will depend on health priorities and the availability of infrastructure and health personnel--as determined by rigorous local situational analysis.     

HIV prevention interventions with gay or bisexual men and youth

This article describes and reviews the findings of several well-designed and controlled outcome trials of HIV prevention interventions that have been undertaken with men who have sex with men. The interventions reviewed have been of two types: face-to-face group or workshop interventions and community-level programs undertaken in gay communities. Both have shown robust effectiveness in promoting risk reduction behavior change among gay men and young people at risk for contracting HIV infection. Conclusions can now be reached about the benefits of these types of interventions. However, there remains an urgent need to develop and tailor HIV prevention approaches that can promote the maintenance of behavior change; to reach community segments that remain vulnerable, especially young and minority men who have sex with men; and to address the changing context of the epidemic.     

Present, prevention, and management of chronic kidney disease in Latin America

In recent decades, Latin America (LA) has experienced profound demographic and epidemiologic changes conditioning an enormous increase in prevalence and incidence of chronic non-communicable diseases. End-stage renal disease has steadily increased in prevalence and incidence (478.2 and 168.7 pmp, respectively) and is emerging as a devastating medical, social, and economic problem for patients, families, and national health systems. The development of successful renal replacement treatment modalities has emphasized the wide breach in healthcare between developed and emerging nations. LA is composed of many nations that have a common social and cultural background yet exhibit significant variations in socioeconomic status, ethnicities, and human development. In addition, the region is experiencing a type 2 diabetes mellitus epidemic and a constant growth of related end-stage renal disease which at present is not sustainable and will be unaffordable in most countries, unless changes in public health policy and a new focus on the problem is generated. Renal transplantation, though increasing, cannot revert the growing prevalence. The development of public health policies and prevention programs is mandatory in LA and requires a better knowledge of prevalence and distribution of risk factors in the different nations of the region.     

Tangible skill building and HIV youth prevention intervention in rural South Africa

This study explores the social representations of HIV and AIDS that circulate among white women teachers in South Africa, a group whose personal risk of the disease is low but who have a major role to play in shaping attitudes to HIV/AIDS among children and young people. The study examines how white women talk about the origin and causes of the spread of HIV in South Africa and their personal and community risk. This was explored through 25 semi-structured interviews and two focus groups with white female teachers in Johannesburg. A thematic analysis of the in-depth interviews revealed a shared private understanding of the disease, wherein the women distanced themselves by anchoring it in the context of racist cultural stereotypes of black sexuality and vulnerability. In contrast, the focus group discussions revealed a type of public talk in which HIV/AIDS is anchored in the contemporary cultural images of the new South Africa and the spirit of ubuntu or togetherness. These contradictory views reflect the racial tensions and social contexts of South Africa and which shape HIV/AIDS discourses. The findings suggest that more needs to be done to create a genuine understanding of HIV and AIDS within contemporary South African contexts.